Fentanyl is a big culprit, but there are also encouraging signs from states that have prioritized public health campaigns and addiction treatment.By Margot Sanger-KatzAug. 15, 2018 New York Times

Drug overdoses killed about 72,000 Americans last year, a record number that reflects a rise of around 10 percent, according to new preliminary estimates from the Centers for Disease Control. The death toll is higher than the peak yearly death totals from H.I.V., car crashes or gun deaths.Analysts pointed to two major reasons for the increase: A growing number of Americans are using opioids, and drugs are becoming more deadly. It is the second factor that most likely explains the bulk of the increased number of overdoses last year.The picture is not equally bleak everywhere. In parts of New England, where a more dangerous drug supply arrived early, the number of overdoses has begun to fall. That was the case in Massachusetts, Vermont and Rhode Island; each state has had major public health campaigns and has increased addiction treatment. Preliminary 2018 numbers from Massachusetts suggest that the death rate there may be continuing to fall.But nationwide, the crisis worsened in the first year of the Trump presidency, a continuation of a long-term trend. During 2017, the president declared the opioid crisis a national public health emergency, and states began tapping a $1 billion grant program to help fight the problem.TO CONTINUE READING: https://www.nytimes.com/2018/08/15/upshot/opioids-overdose-deaths-rising-fentanyl.html

Fentanyl is a big culprit, but there are also encouraging signs from states that have prioritized public health campaigns and addiction treatment.By Margot Sanger-KatzAug. 15, 2018 The New York Times

Drug overdoses killed about 72,000 Americans last year, a record number that reflects a rise of around 10 percent, according to new preliminary estimates from the Centers for Disease Control. The death toll is higher than the peak yearly death totals from H.I.V., car crashes or gun deaths.Analysts pointed to two major reasons for the increase: A growing number of Americans are using opioids, and drugs are becoming more deadly. It is the second factor that most likely explains the bulk of the increased number of overdoses last year.The picture is not equally bleak everywhere. In parts of New England, where a more dangerous drug supply arrived early, the number of overdoses has begun to fall. That was the case in Massachusetts, Vermont and Rhode Island; each state has had major public health campaigns and has increased addiction treatment. Preliminary 2018 numbers from Massachusetts suggest that the death rate there may be continuing to fall.But nationwide, the crisis worsened in the first year of the Trump presidency, a continuation of a long-term trend. During 2017, the president declared the opioid crisis a national public health emergency, and states began tapping a $1 billion grant program to help fight the problem.TO CONTINUE READING:​https://www.nytimes.com/2018/08/15/upshot/opioids-overdose-deaths-rising-fentanyl.html

The Food and Drug Administration on Monday announced a shift in the way it evaluates drugs to treat opioid addiction that the agency says will give it more flexibility to approve new treatments.Now, rather than merely examining whether a potential treatment reduces opioid use, the agency will consider factors like whether a drug could reduce overdose rates or the transmission of infectious diseases.“We must consider new ways to gauge success beyond simply whether a patient in recovery has stopped using opioids, such as reducing relapse overdoses and infectious disease transmission,” FDA Commissioner Scott Gottlieb said in a statement.

The announcement is the latest in a string of efforts to improve the federal government’s response to the growing opioid crisis, which also includes legislation on Capitol Hill that aims to ensure treatment is evidence-based and, separately, to ensure more federal programs will pay for methadone treatment.The many outcomes Gottlieb cited included mortality (both overall and from drug overdoses) and disease transmission, given the many communities that have seen outbreaks of HIV/AIDS and hepatitis concurrent with increased rates of injection drug use.MAT, coupled with psychosocial counseling, is widely acknowledged to be the standard of care in treating opioid addiction.Currently, just three drugs exist to treat opioid use disorder: buprenorphine, methadone, and naltrexone. Adherence to the drugs is typically low, and addiction treatment experts have long said MAT is vastly underutilized, calling for expanded access to existing options and the development of more drugs beyond the existing three.In its guidance, the FDA said encouraging drug developers to consider outcomes beyond drug use could yield significant health benefits.

HHS.govJuly 17, 2018By: Corinna Dan, R.N., M.P.H., Viral Hepatitis Policy Advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services and Adm. Brett P. Giroir, M.D., Assistant Secretary for HealthSummary: Some communities that have been hardest hit by the opioid crisis have also seen associated increases in hepatitis B and C and other infections.

The opioid crisis in the United States is devastating the lives of millions of Americans. Perhaps overshadowed by the alarming rise in overdoses and deaths is the accompanying numbers of injection-related infectious diseases. Opioid overdose deaths increased fivefold from 1999 to 2016, and new hepatitis C infections more than tripled from 2010 to 2016.Some communities that have been hardest hit by the opioid crisis have also seen associated increases in hepatitis B and C and other infections, such as endocarditis, septic arthritis and abscesses, driven by increases in the numbers of people who inject opioids.Earlier this year, the HHS Office of the Assistant Secretary for Health’s Office of HIV/AIDS and Infectious Disease Policy and the Office on Women’s Health sponsored a workshop at the National Academies of Sciences, Engineering and Medicine to explore the infectious disease consequences of the opioid crisis and consider opportunities to better integrate effective responses. A detailed summaryof the proceedings is newly available.One of HHS’s top priorities is the implementation of a comprehensive national opioid strategy. The HHS five-point opioid strategy emphasizes the need to empower local communities to assess and respond to local needs, including both drivers and consequences of the opioid crisis. The National Academies’ workshop highlighted the importance of addressing infectious diseases as part of an improved, comprehensive opioid response.The opioid crisis is part of a set of interconnected health problems, often called syndemics, because they have common root causes and interact synergistically, with one problem making the others worse. Because syndemics are interconnected, coordinated efforts are required across multiple programs and partners to successfully overcome the set of problems and their consequences.The federal government can’t fight this battle alone. We recognize that some of the best and most effective solutions will come from healthcare providers, community leaders and law enforcement who are dealing with the opioids and infectious diseases crisis on the ground.

(CNN)Death rates from liver cancer increased 43% for American adults from 2000 to 2016, according to a report released Tuesday by the US Centers for Disease Control and Prevention's National Center for Health Statistics. The increase comes even as mortality for all cancers combined has declined.Liver cancer death rates increased for both men and women 25 and older, as well as white, black and Hispanic people. Only Asians and Pacific Islanders saw a decrease in mortality from liver cancer.

HPV test more effective than Pap smear in cancer screening, study suggestsThe rise in mortality doesn't mean that liver cancer is deadlier than before, according to Dr. Jiaquan Xu, the author of the report; the 10-year survival rate for liver cancer didn't change much. Rather, the increase in mortality means more people are developing liver cancer.More than 70% of liver cancers are caused by underlying liver disease, which has risk factors such as obesity, smoking, excess alcohol consumption, and hepatitis B and C infection, said Dr. Farhad Islami, the scientific director of cancer surveillance research at the American Cancer Society."I think the main reason for the increase in liver cancer incidence and death rate in the US is the increase in the prevalence of excess body weight and hepatitis C virus infection in baby boomers," said Islami, who authored a study on liver canceroccurrence between 1990 and 2014.New hepatitis C infections triple due to opioid epidemicUp until 1992, blood transfusions and organ transplants were not screened for hepatitis C, Xu said. According to the CDC, this was once a common means of hepatitis C transmission.It is often years before a person living with hepatitis C develops liver cancer, which would account for an increase in incidence of the cancer among older individuals who received blood transfusions and organs before 1992. Liver cancer mortality was greatest in those 75 and older, followed by those 65 to 74 and 55 to 64, according to the new report.The opioid epidemic might also be at fault, said Dr. Manish A. Shah, a medical oncologist at Weill Cornell Medicine and NewYork-Presbyterian. Hepatitis C, spread by sharing needles, drove elevated rates of liver cirrhosis, or scarring due to damage to the liver, in the 1990s and 2000s, Shah said. Cirrhosis increases the risk for liver cancer, although it is not clear why, he added.Xu said he hopes people realize lifestyle changes can decrease their risk of developing liver cancer."Some of these liver cancer risk factors like obesity, diabetes and excess consumption of alcohol, those things can be prevented," he said.TO CONTINUE READING: https://www.cnn.com/2018/07/17/health/liver-cancer-death-rate-study/index.html?no-st=1531863435.

​As the map shows, the programs are banned in most of the South and much of the West.At the federal level, needle exchanges aren’t banned. But until as recently as 2016federal dollars were not allowed to go to such programs.Now, legalization doesn’t necessarily mean that needle exchanges can be easily opened and remain in place. In California’s Orange County, for example, local officials shut down the district’s only needle exchange and have tried to prevent its reopening.Needle exchanges not only provide a place where people can obtain syringes for drug use or dispose them. They also can help link people to other services, including addiction treatment, vaccinations, and infection testing. The driving idea behind the programs is this: Recognizing the reality that some people do use drugs, it’s better to provide them somewhere to pick up new, sterile syringes (without the risk of spreading, say, HIV or hepatitis C infection) than to turn them away from potential public health services and force them to reuse needles despite the hazards.The decades of research about needle exchanges is clear: The programs combat the spread of blood-borne diseases like hepatitis C and HIV, cutdown on the number of needles thrown out in public spaces, and connect more people to treatment — all without enabling more drug use. This is an exhaustive body of research, backed by independent academic researchers, the World Health Organization, and the Centers for Disease Control and Prevention.Yet needle exchanges often face resistance due to stigma and concerns that the programs will attract drug users to an area and lead to more drug-related problems. In Orange County, officials in Santa Ana, the county seat, said that the needle exchange program there led to a massive increase in the amount of needle litter in public areas.Advocates of such exchanges argue that the people using drugs already live in these areas. They are just using them without any place to reliably visit to pick up sterile syringes.Supporters of needle exchanges also point to studies that show the programs actually reduce drug-related problems such as needle litter.For example, a 2012 study published in Drug and Alcohol Dependence compared a city with needle exchanges, San Francisco, to one without exchanges, Miami. Through visual inspections, researchers found 44 syringes per 1,000 census blocks in San Francisco, compared with 371 syringes per 1,000 census blocks in Miami. Based on a survey of injection drug users in both cities, the researchers also concluded that users in Miami had more than 34 times the adjusted odds to improperly dispose of syringes in public than users in San Francisco.“These results suggest that [needle exchanges] are a significant means of collecting used syringes and do not increase the amount of publically discarded used syringes,” the study concluded.TO CONTINUE READING: https://www.vox.com/science-and-health/2018/6/22/17493030/needle-exchanges-ban-state-map

When it comes to combating opioid misuse and addiction, needle exchanges and safe injection sites have decades of evidence behind them. Yet a new study published in Preventive Medicine found that a majority of Americans oppose both — and stigmatizing attitudes toward people with addiction appear to be to blame.For the study, researchers conducted a survey of more than 1,000 Americans asking about their attitudes on needle exchanges, safe injection sites, and addiction more broadly. They found that about 39 percent of Americans support needle exchanges, while around 29 percent back safe injection sites.The survey also measured respondents’ stigmatizing attitudes toward addiction, putting together a composite of questions — whether they’d be willing to have a person who is using opioids marry into their family or start working closely with them on a job, and their overall feelings of people who use opioids.The researchers concluded: “Individuals with higher stigma toward peoplewho use opioids were less likely to support legalization of safe consumption sites … or syringe services programs.”Needle exchanges are places where someone can dispose of used syringes, which are used to inject drugs, and obtain sterile syringes. The idea is that although you can’t stop everyone from using drugs, you can at least minimize the harms of drug use. The decades of research into such programs is clear: They combat the spread of bloodborne diseaseslike hepatitis C and HIV, cutdown on the number of needles thrown out in public spaces, and link more people to treatment — all without enabling more drug use.Safe injection sites, meanwhile, provide a place for people to use drugs under medical supervision in case anything goes wrong — like, say, an overdose. Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction in 2017 concluded that safe injection sites led to “safer use for clients” and “wider health and public order benefits.” Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service call-outs related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.Yet despite the preponderance of empirical evidence supporting needle exchanges and safe injection sites, stigma holds back these policies. This is something I’ve seen time and time again in my reporting on the opioid epidemic. For example, when I asked the architects of Vermont’s “hub and spoke” system — which integrates addiction treatment into the rest of health care — what the biggest hurdles were to implementation, the barriers were not so much money or lack of evidence, but stigma.John Brooklyn, a chief architect of the hub-and-spoke system, referred to perceptions of evidence-based anti-addiction medications like buprenorphine as an example: “It’s now 14 years after buprenorphine’s been approved [by the Food and Drug Administration], and you still have an awful lot of docs — you even have our [former] secretary of health and human services — who [say] medication-assisted treatment is just a crutch.”Or consider one of the emails I received in response to a story on opioids: “Darwin’s Theory says ‘survival of the fittest.’ Let these lost souls pay the price of their criminal choices and criminal actions. Society does not owe them multiple medical resuscitations from their own bad judgment, criminal activity, and self-inflicted wounds.”TO CONTINUE READING:hen it comes to combating opioid misuse and addiction, needle exchanges and safe injection sites have decades of evidence behind them. Yet a new study published in Preventive Medicine found that a majority of Americans oppose both — and stigmatizing attitudes toward people with addiction appear to be to blame.For the study, researchers conducted a survey of more than 1,000 Americans asking about their attitudes on needle exchanges, safe injection sites, and addiction more broadly. They found that about 39 percent of Americans support needle exchanges, while around 29 percent back safe injection sites.The survey also measured respondents’ stigmatizing attitudes toward addiction, putting together a composite of questions — whether they’d be willing to have a person who is using opioids marry into their family or start working closely with them on a job, and their overall feelings of people who use opioids.The researchers concluded: “Individuals with higher stigma toward peoplewho use opioids were less likely to support legalization of safe consumption sites … or syringe services programs.”Needle exchanges are places where someone can dispose of used syringes, which are used to inject drugs, and obtain sterile syringes. The idea is that although you can’t stop everyone from using drugs, you can at least minimize the harms of drug use. The decades of research into such programs is clear: They combat the spread of bloodborne diseaseslike hepatitis C and HIV, cutdown on the number of needles thrown out in public spaces, and link more people to treatment — all without enabling more drug use.Safe injection sites, meanwhile, provide a place for people to use drugs under medical supervision in case anything goes wrong — like, say, an overdose. Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction in 2017 concluded that safe injection sites led to “safer use for clients” and “wider health and public order benefits.” Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service call-outs related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.Yet despite the preponderance of empirical evidence supporting needle exchanges and safe injection sites, stigma holds back these policies. This is something I’ve seen time and time again in my reporting on the opioid epidemic. For example, when I asked the architects of Vermont’s “hub and spoke” system — which integrates addiction treatment into the rest of health care — what the biggest hurdles were to implementation, the barriers were not so much money or lack of evidence, but stigma.TO CONTINUE READING: https://www.vox.com/science-and-health/2018/6/7/17434480/needle-exchange-safe-injection-site-stigma-study

​The deaths of the designer Kate Spade and the chef Anthony Bourdain, both of whom committed suicide this week, were not simply pop culture tragedies. They were the latest markers of an intractable public health crisis that has been unfolding in slow motion for a generation.Treatment for chronic depression and anxiety — often the precursors to suicide — has never been more available and more widespread. Yet the Centers for Disease Control and Prevention this week reported a steady, stubborn rise in the national suicide rate, up 25 percent since 1999.The rates have been climbing each year across most age and ethnic groups. Suicide is now the 10th leading cause of death in the United States. Nearly 45,000 Americans killed themselves in 2016, twice the number who died by homicide.After decades of research, effective prevention strategies are lacking. It remains difficult, perhaps impossible, to predict who will commit suicide, and the phenomenon is extremely difficult for researchers to study.One of the few proven interventions is unpalatable to wide swaths of the American public: reduced access to guns. The C.D.C. report found that the states where rates rose most sharply were those, like Montana and Oklahoma, where gun ownership is more common.It is predominantly men who use guns to commit suicide, and men are much less likely to seek help than women.The escalating suicide rate is a profound indictment of the country’s mental health system. Most people who kill themselves have identifiable psychiatric symptoms, even if they never get an official diagnosis.The rise in suicide rates has coincided over the past two decades with a vast increase in the number of Americans given a diagnosis of depression or anxiety, and treated with medication.The number of people taking an open-ended prescription for an antidepressant is at a historic high. More than 15 million Americans have been on the drugs for more than five years, a rate that has more than tripled since 2000.TO CONTINUE READING: https://www.nytimes.com/2018/06/08/health/suicide-spade-bordain-cdc.html?emc=edit_th_180609&nl=todaysheadlines&

(May 25, 2018) HCVguidelines.org — a website developed by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) to provide up-to-date guidance on the management of hepatitis C (HCV) — has updated several sections of the website to reflect new testing and management recommendations for pregnant women, people who inject drugs, men who have sex with men and people who are incarcerated.“Today, hepatitis C is curable for over 95 percent of people who undergo treatment,” explain HCV Guidance Co-Chairs, Marc G. Ghany, MD, MHSc; Arthur Y. Kim, MD; Kristen M. Marks, MD; and Hugo E. Vargas, MD. “With the success of HCV treatments, the medical community must now shift our focus toward eliminating HCV as a public health problem. As a first step, our Panel has made new recommendations to re-emphasize the importance of testing key populations and treating virtually all patients with the virus. We feel these recommendations are in alignment with the 2016 World Health Organization and National Academies of Sciences, Engineering and Medicine (NASEM) goals of eliminating HCV infection by 2030.”Universal screening for pregnant womenDrawing from recent studies highlighting a sharp increase of HCV-infected women giving birth in the United States between 2011-2014, and a lack of evidence that risk-factor-based testing is effective in identifying chronic HCV infection, the updated HCV Guidance recommends all pregnant women be tested for HCV infection, ideally at the start of their prenatal care.By screening all pregnant women at the beginning of prenatal care, physicians will increase opportunities for education and referral and allow early testing and treatment for exposed infants. Treatment of women post-pregnancy will improve the health of women and ultimately prevent future HCV transmission.Men who have sex with menSeveral outbreaks of sexually transmitted HCV infection among HIV-infected men who have sex with men have been reported since 2000. Additionally, HCV incidence is increasing among HIV infected men who have sex with men.With these things in mind, the Panel has made new recommendations that focus on sexually active adult and adolescent men who have sex with men who are HIV-infected, who are initiating pre-exposure prophylaxis (PrEP) for HIV, or who have been successfully treated or spontaneously cleared HCV infection.For these men, the Guidance recommends:

At least annual (or more often, based on risk) testing for HCV antibody for those who have never been exposed to the virus.

HCV RNA testing for those who were treated or spontaneously cleared HCV infection.

People who inject drugsTo address the growing number of cases of HCV infection due to the opioid epidemic, the updated Guidance recommends annual HCV testing for people who inject drugs and have never been tested for the virus. The guidance also recommends annual testing for people who have previously tested negative for the virus but continue to use injection drugs and treatment for those who test positive.Additionally, the Guidance recommends:

Substance use disorder treatment programs and needle/syringe exchange programs should offer routine, opt-out HCV antibody testing with reflexive or immediate confirmatory RNA testing and connection to care for those who are infected.

People who inject drugs should be counseled on measures to reduce risk of HCV transmission to others.

People who inject drugs should be connected to harm reduction services when available, including needle/syringe service programs and substance use disorder treatment programs.

People in correctional institutionsResearch has shown that HCV infection disproportionately affects people in correctional institutions. The updated Guidance recommends that jails and prisons should implement opt-out testing for incarcerated individuals.The Guidance also recommends:

Chronically infected people in jail settings should receive counseling about HCV infection and be connected to follow-up community health care for evaluation of liver disease and treatment upon release.

Chronically infected people in prisons — and those whose jail sentences are sufficiently long enough to complete a total course of antiviral therapy — should receive antiviral therapy according to AASLD/IDSA Guidance while incarcerated. Upon release, these patients should be connected to community health care to monitor for HCV-related complications.

To prevent HCV re-infection and reduce the risk of progression of HCV-associated liver disease, prisons should provide harm reduction and evidence-based treatment for underlying substance use disorders.

Jails and prisons should facilitate continuation of HCV therapy for individuals on treatment at the time of incarceration.

Visit HCVguidelines.org for more information about these recommendations and to view other sections of the HCV Guidance.About AASLDAASLD is the leading organization of clinicians and researchers committed to preventing and curing liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.Visit aasld.org to view AASLD’s evidence-based practice guidelines and guidances.About IDSAThe Infectious Diseases Society of America (IDSA) is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, prevention, and patient care. The Society, which has over 10,000 members, was founded in 1963 and is based in Arlington, VA. For more information, see www.idsociety.org.Visit www.idsociety.org/HCV/ to access IDSA’s extensive collection of resources on hepatitis C, including the Society’s Core Curriculum for HCV at www.idsociety.org/HCV_Curriculum/#Introduction.

”Opposing needle exchanges and insisting people with addiction must hit “rock bottom” flies in the face of reality.

​By Maia SzalavitzMarch 13Maia Szalavitz is a journalist and author, most recently of “Unbroken Brain: A Revolutionary New Way of Understanding Addictions.

In the face of an unabating overdose crisis that has already killed more than a half-million people, San Francisco, Philadelphia and Seattle have announced plans to do what was once unthinkable: open centers where people can inject illegal drugs under medical supervision. Many other cities are also debating so-called safe infection facilities (SIFs) — but unfortunately, a common misconception about addiction stands in the way.SIFs, also known as Overdose Prevention Sites or Supervised Consumption Centers, have operated for years in at least 66 cities in Europe, Canada and Australia. They reduce overdose mortality, cut transmission of HIV and hepatitis C, decrease public injecting and the presence of dirty needles in streets and parks, and even reduce local crime and violence rates — all while improving health. Despite millions of injections carried out by thousands of people, no one has ever died of an overdose at an SIF, according to Brandon Marshall, an associate professor of epidemiology at Brown University, who has studied these programs.Instead, opponents argue that SIFs “enable” addiction — and that by mitigating risk, they prolong drug use by preventing people with addiction from suffering the consequences needed to motivate them to recover. In 2017, anti-SIF residents and politicians in Seattle organized a ballot initiative to block the city’s SIF plans, which garnered more than 47,000 signatures and qualified it for a vote. (The referendum was later blocked by a judge for procedural reasons).In an op-ed laying out his opposition, Redmond, Wash., city council member David Carson put it this way: “It’s difficult to see how enabling addicts to continue a terribly destructive lifestyle is compassionate. Every recovering addict will tell you that they had to hit rock bottom before they wanted to change and that desire must drive their recovery.” Similar comments have been heard from opponents in San Francisco, Philadelphia and elsewhere.The concept of “enabling” comes from 12-step recovery, based on the self-help group Alcoholics Anonymous. The idea is that friends and family must not support loved ones while they continue to use drugs or help them avoid dangerous consequences — otherwise, they might delay “rock bottom.” The vast majority of addiction treatment providers in America teach this perspective, even though there’s no research to support the idea that “enabling” is harmful.Gigabytes of real-world data show the opposite. In the 1990s, the “enabling” argument was used to fight clean needle programs to prevent the spread of disease — and it helped delay their implementation. Even today, states with growling levels of IV drug use, such as Indiana and Florida, continue to have fights over these programs. Officials in Indiana have shut down several because of moral fears about enabling.